Theory is situated in history and context of other disciplines:Tenets of Palombo’s Nonlinear Dynamic Systems Theory

Terminology and Premises:

Nonlinear causality

Noncontiguous direction of change

Sensitivity to initial conditions

Preferences and Biases

Emergent Properties

Attractors or Attractor Basins

Self-Organization

Stable or unstable

Open or closed

Self-Similarity

Levels in a Neuropsychodynamic Approach

L1: Neuropsychological

L2: Introspective

L3: Interpersonal

Moments: “Organizing events that capture the essence of the issues with which the patient is struggling at a given time during the process. These moments do not necessarily arrive sequentially but occur episodically. Moments are activated when specific types of exchanges in the process between the therapist and patient are in the foreground of the interaction.” (Palombo, in press)

Concordant

Complementary, “Mindsharing”

Adjunctive

Selfobject

Disjunctive

“It is often difficult to make a clear-cut distinction between selfobject and adjunctive functions when people are involved in the performance of these functions. In addition to selfobject functions, patients with self-deficits tend to draw adjunctive functions from others that complement their immature or deficient psyches. These processes are most evident in patients with neuropsychological deficits, where through their neuropsychological deficits they call out to us for complementary responses. Whether they are open to receiving what we have to offer will depend on the level of their distress or whether their defenses will stand in the way of their availability to use what is offered, i.e., whether theirs is a system in which their sense of self is open or closed. What will become evident is that the processes involved in these interchanges will replicate themselves in the clinical setting and will inform the type of relationship established between a patient and a therapist” (Palombo, in press).

Mindsharing: “The process through which we are able to empathize with others’ experiences and they to ours…for the development of a stable sense of self-cohesion (Palombo, 2001).

Self-organizing change agents:

1. The Relationship

2. Our clinical interpretation

3. Clients’ proactive engagement

2. “Central to this process is the development of the patients’ self-reflective capacities and their self-understanding. From a systems perspective, understanding must include the nature and place of the neuropsychological deficits in the formation of the patients’ personality. Without the validation of these self-deficits as contributors to the patients’ difficulties, a critical component would be missing. Explanations facilitate the process of self-understanding by permitting patients to clearly identify the types and sources of their self-deficits, whether of selfobject or adjunctive functions, and allow them to begin to think about the effects these have had on their lives. The insights that are necessary to provide patients’ with a comprehensive picture of what occurred are essential to the healing process. By making explicit, through interpretations, their psychodynamic formulations, therapists convey their understanding of the patient through their interpretations. In a manner of speaking, we can say that those formulations constitute the therapist’s narrative….The narratives that therapists use to formulate the patients’ dynamics differ from those that patients have put together. Therapists find different or deeper meanings to the events than patients thought existed. Informed therapists have explanations for the patients’ distress and experiences that the patients lacked. The therapeutic dialogue permits patients to reorganize their self-narratives by integrating the new information gained through the process. The outcome hoped for is that along with the modification of the patient’s self-narrative, the dyad arrives at the co-construction of a more coherent narrative, which integrates the patient’s narrative with that of the therapist” (Palombo, in press).

3. “For patients with LD, the acquisition of practical ways of dealing with their adjunctive deicits must accompany those changes. Examples are the outright avoidance of tasks tha are dependent on those skills for the successful completion, or through compensatory activities that permit the patients to accomplish tasks by using alternative means, or through remediation that permits the strengthening areas of weakness….The question we confront is that of the place of educational directives in the therapeutic relationship.” (Palombo, in press)

Applications to Educational Therapy

Educational Therapy is to teaching what Psychotherapy is to advice.

“An integral part of this approach is that patients receive remediation for their self-deficits. Much as patients who has suffered a major injury must go through a rehabilitative process to recover lost functions. What this means is that there is a rehabilitative component to the restoration of the self in patients with self-deficits. It involves the remediation of the self-deficits through the acquisition of new skills or other forms of intervention. I suggest that much as patients with traumatic brain injuries require physical rehabilitation to regain some of their former levels of functioning so do patients with neuropsychological deficits. In the case of the latter, therapists direct their interventions to the cognitive realm rather than the physical realm. Since most therapists are not equipped to provide the types of instruction that these patients require, a referral to appropriate specialists, such as occupational therapists, speech and language therapists, educational therapists, or other specialists ought to be made” (Palombo, in press).

Examples of Moments in Ed Therapy sessions:

“Facial Feedback with Daniel” To invite a

Disjunctive Moment:

Concordant Moment:

Complementary

Adjunctive Moment: Selfobject Moment:

“Architecture of Sessions: Initiation and Salience with Jennifer”To invite a

A new neuroscience twist on a classic psychology study offers some clues to what makes one student able to buckle down for hours of homework before a test while his classmates party.

The study, published in this month’s edition of Proceedings of the National Academy of Science, suggests environmental cues may “hijack” the brain’s mechanisms of self-control in some people and some circumstances.

The findings add to a growing body of research suggesting that a student’s ability to delay gratification can be as important to academic success as his or her intelligence—and that educators may soon know how to teach it.

More than 40 years ago, Stanford University researchers led by Walter Mischel conducted a now-famous studyin self-control: They asked 4-year-olds at Stanford’s Bing Nursery School to hold off eating one sweet in exchange for the promise of two sweets 15 minutes later. Fewer than one in three children passed the so-called “marshmallow test.”

In the years that followed, numerous follow-up and variation studies have foundthat the preschoolers who managed to delay gratification were also more likely later on to do well in school, avoid substance abuse, maintain a healthy weight, and even perform better on the sat than peers who couldn’t resist temptation.

The studies by Mr. Mischel, who is now a psychology professor at Columbia University, and a cadre of other researchers have helped change the way scholars and educators think about why students succeed academically. In a separate self-control study, Angela L. Duckworth, an assistant psychology professor at the University of Pennsylvania, even found that self-control was a better predictorof a student’s academic performance than an IQ test.

Yet the brain has remained a missing piece of the puzzle, according to B.J. Casey, the director of the Sackler Institute for Developmental Psychobiology at the Weill Cornell Medical College in New York City. The new study is the first to compare brain differences among those original Stanford preschoolers.

“What we wanted to do is try to understand how the brain is related to this behavior,” said Ms. Casey, who led the new study. Brain imaging, she said, “is helping us to disentangle the impulse control from sensitivity to rewards and social cues.”

Control in the Brain

Of the 562 Bing Nursery School pupils who took part in the original Stanford study in the late 1960s and early 1970s, 155 participated in a follow-up in 1993 and 135 in another in 2003. Ms. Casey’s team focused on 60 who consistently showed a high ability to delay gratification and another 57 with consistently low ability to delay.

Marshmallows and pretzels may not hold the same allure for those in their 40s as they do for preschoolers, but the enjoyment of a positive social cue, such as a smiling face, has proved to be just as powerful emotionally for adult study participants.

Ms. Casey and her team tested the participants’ ability to push a button—or refrain from pushing it—in response to seeing images of happy, fearful, or neutral faces. After conducting the first round of tests, the team asked 27 of the participants to redo the trials while undergoing functional magnetic resonance imaging, or fMRI, which uses blood flow to measure activity in the brain.

Researchers found that the brain seems to bring two different areas to bear when a decision is made.

In an objective, unemotional question—Is it better to have one item now or two items in 15 minutes?—the brain triggers the prefrontal cortex, which helps us make rational decisions. Other decisions are more urgent and more dependent on context—Should I run from the wolf? Should I eat this food?—and here, environmental and social cues can activate a deeper, more primitive part of the brain, the ventral striatum, which is associated with processing desires and rewards.

As it turns out, Ms. Casey said, people who have difficulty delaying gratification also tend to be “very, very sensitive to environmental cues.” All of the adults in the study were able to respond correctly in neutral situations. Differences arose between the adults who could delay gratification as children and those who couldn’t during tests in which they were asked to counter a strong environmental cue.

The biggest difference between the two groups occurred when participants had been asked to press the button several times in a row for a happy face, which researchers consider a strong positive social cue, and then suddenly were asked not to respond to happy faces. Those who had demonstrated poor delay of gratification as children were much more likely to push the button in response to a happy face even when they were not supposed to do so.

Environmental Cues

“Sensitivity to environmental cues influences an individual’s ability to suppress thoughts and actions, such that control systems may be ‘hijacked’ by a primitive limbic system, rendering control systems unable to appropriately modulate behavior,” the researchers found.

Experts said this finding might help explain the dip in self-control that parents and teachers often report in teenagers.

“We’ve shown developmentally that [impulse control and environmental sensitivity] are separate; impulse control gets better and better as you get older,” Ms. Casey said. “Children are more impulsive than adolescents, but right around puberty there’s a much greater sensitivity to social cues and environment, and adolescents are more sensitive to social cues than either children or adults.”

Teasing out how impulse control and environmental sensitivity work together has “strong implications” for ways of intervening with children and adults who have trouble with self-control, she said.

For example, prior studies have found that young children can hold off eating a marshmallow if they are told to focus on “cool” cues like its shape or color, rather than emotionally “hot” cues like taste.

And Adele Diamond, a professor of developmental cognitive neuroscience at the University of British Columbia, in Vancouver, foundthat preschoolers can learn to wait to take turns more effectively when they are given concrete social cues, such as holding a picture of a mouth when speaking and a picture of an ear when listening.

Mr. Mischel and Ms. Duckworth have been studying whether it’s possible to teach students how to delay gratification and improve self-control through school-based interventions.

In a 2010 study, Ms. Duckworth found that high school students who visualized both their academic goal for an upcoming high-stakes exam and potential pitfalls in meeting that goal answered 60 percent more questions on a practice exam than peers who had not done the exercise.

Ms. Duckworth is currently working on two separate evaluations of self-control instruction in New York City and Philadelphia.

In New York, four charter middle schools operated by the Knowledge Is Power Program, or KIPP, a San Francisco-based education-management organization, started their pilot last year, adding character grades to students’ academic report cards twice a year. The report cards have seven indicators—zest, grit, self-control, hope/optimism, curiosity, gratitude, and social intelligence—and include a two-part measure of a student’s self-control that takes into account both academic and social behavior. This year, the schools are testing class lessons on strategies to improve self-control.

In the Field

Last week, Mitch Brenner, the assistant principal at the KIPP Academy Middle School in New York, used one such lesson to explain the original “marshmallow experiment” to a class of 6th graders. He asked them to talk about how they would have decided whether or not to eat the sweet, and how self-control relates to the school’s academic requirements.

“We are asking kids to make sacrifices in the course of their careers here,” said Mr. Brenner, who is developing the lessons as part of the pilot study. “You are putting in long hours, you are doing homework while you would rather be playing video games or watching TV, and that can have benefits down the road, but it can be tough, particularly for a kid. We want to give them exposure to that idea, motivate them and help get them thinking.”

The KIPP school also created a “character-rific” honor board to leverage adolescents’ social sensitivity to improve rather than impede their self-control. Students nominate classmates or teachers as having good character based on self-control and other qualities.

“I can tell kids all day what grit looks like, what self-control looks like, but when the kids give the examples, that’s where the real power comes from,” Mr. Brenner said. “Some kids may struggle more academically, but when they get shouted out as being a good person, that feels great.”

Back in Mr. Brenner’s class on self-control, students got their own marshmallows and debated the pros and cons of immediate versus delayed gratification. At the end of the class, Mr. Brenner let the students eat their marshmallows—though one boy opted to save his for later.

Note:

“In the years that followed, numerous follow-up and variation studies have foundthat the preschoolers who managed to delay gratification were also more likely later on to do well in school, avoid substance abuse, maintain a healthy weight, and even perform better on the sat than peers who couldn’t resist temptation”

"[In the fMRI,] we have this combination of the [cortical] area thought to be involved in self-monitoring turning off and this area thought to be autobiographical or self-expressive turning on...In order to be creative, you need to have this dissociation within your frontal lobe"

I'm pretty sure this synchrony way of looking at brain function will answer a lot of the questions that traditional static models have left unanswered or even led us astray (like the apocryphal Grandmother Cell error)

One of my favorite metaphors of science is in the story of a man searching desperately in the pitch black night for his missing car keys under a streetlamp. A woman approaches him and asks, "Where did you lose your keys?" The man replies, "I don't know where I lost them, but I'm looking here under the light because that's where I can see."

Science's desperate search for the creativity in music is just nascent - under the blue light of an fMRI - but I'm encouraged.

Friday, December 24, 2010

1. Online School Portals- As of this month, the last North Shore School (surprising who took the longest) now has the ability for parents to know assignment grades before kids get them in class. Pros: smooth flow of information through the "assignment circle (of Doom)-see below. Cons: the wrong people can tend to the information (read: parent anxiety alert!), and heck, who needs an assignment notebook now?

2. Response to Intervention - the transformation is complete (ly stupefying). By this point, schools are now agents of RTI ("Really Timeconsuming Interference"). Those who used to be called school psychologists are now "intervention specialists," the burden on classroom teachers is multiplied, the "diagnosis by treatment failure" model-ridiculed in medicine-is the M.O., the most amazing curricula are justified as "research based," and the kids who I know would benefit from some good school-based individually catered instruction are now delayed the help we all know they need.

3. Everything you need to know is now in most kids pockets - iPhones and other mobile technology are now more ubiquitous than pens/pencils in my office. It forces a wonderful shift from teaching as dumping of information to filtering of relevance.

4. Spell Links program - By now you should know I am not a lock-step programmatic thinking kinda guy; however, Jan Wazowicz's next project after the ubiquitous Earobics auditory processing success promises to be a player nationally as it takes language-based, theory-driven, individually-tailored genius to the realm of spelling and decoding. Access points include Holly Shapiro's Ravinia Reading Center.

5. The spectrum is now on our collective cultural radar - autism spectrum disorders, including Aspergers (which will disappear in the new DSM-V proposed this year) are talked about the media, in heart-felt ways, making us all begin to notice the subtlety inherent in nonverbal communication. Did ya know that contagious yawning happens less in young kids with autism?

Wednesday, March 10, 2010

I've been thinking about how often we try to solve our kids' academic difficulties with the decree to "just try harder."

First, I'm always skeptical of any solution that starts with the word "Just..." If it were a simple solution, any reasonable person would have already run across it.

Second, who are the people recruiting this decree? In my experience, many dads, often very successful, want their kids to overcome difficulties by just trying harder. Another recent cohort I've been hearing this from, interestingly, is kids themselves after they achieve a big breakthrough. [I try to analyze the successes at least as much as the setbacks.] He finally got an A on that test because, "I don't know, I just tried harder." So, if parents and kids say so, the "just try harder" solution is correct, right? Not really. Because it doesn't really help on the front side of the chasm. It only works when looking back after success.

Here's my explanation of the Just Try Harder ("JTHTM"?) reasoning and why I think it's so popular:

There is a well documented phenomenon in research on children's memory for collaborative activites (e.g., Foley et al., 2002) in which children tend to over-attribute contributions to themselves. Here's what I mean: A 4- or 5- year- old child puts a puzzle together with a parent, and afterward, an experimenter asks, "Who was the person to put this piece of the puzzle in the right spot, you or your mom?" The kid thinks back, and says, "Me. I put it there." Kids tend to correctly say they did it when they indeed put the piece there. They also tend to say they did it when in fact review of a videotape shows that the parent and kid did it together...or even sometimes when the parent in fact put the piece there. This happens time and time again: a consistent memory error in which kids think they did more to solve a problem than they actually did.

Is this a bad thing? Actually, we consider this an "adaptive memory error," for it turns out that time after time, the kids that make this error 1) try harder on the next puzzle they do without help from parents, and 2) tend to do better on subsequent puzzle tasks. Why fix what works? In my clinical work, we tend to like seeing kids make these types of memory errors.

So what does this have to do with parents solving their kid's academic problem with the decree to "just try harder?" Often, at first pass, we all try to solve our kid's troubles by looking back on our own experiences. Sure, why not? Worked for me, so it may work for Junior! (It's a data set of N=1) So we look back on our own earlier academic successes. (BTW, it turns out we really retain quite few memories from school: mostly just the really salient five that get turned into anecdotes) and we often make the same adaptive memory errors as those 4 year old puzzle builders:

We look back over our education, our 12 or 16 or more years of carefully calibrated assistance from parents, teachers, and others, and we over-attribute contributions to ourselves: "I passed that class because I stayed up all night to finish that paper" or the like. Again, in life these are adaptive memory errors. They cause us to put in more effort on the next challenge! The only problem in this situation is that the memory belongs to the older generation, but the effort is supposed to belong to the younger generation.

Monday, February 15, 2010

Well, the new DSM-V (Diagnostic and Statistical Manual of Mental Disorders), the bible of psychology is now drafted, as of this week.

My head is swimming, especially considering earlier blogs on semantics and labeling.

There is no more Asperger's Syndrome. Aspies will now be considered "Autistic Spectrum Disorders." What a weird experience, I presume: to have a name you have likely grappled with, identified with, used to find others like you, or explained time after time YANKED out from underneath you. Now you are situated along a continuum, seen as a mild version of others. Aspergers' is now referred to as a "personality type" and "is outside the scope of DSM, which explicitly concerns clinically-significant and impairing disorders."

There will be no more Writing Disorder. No more Learning Disability, Not Otherwise Specified. The process of categorizing has always felt a bit like squeezing round pegs into square holes (often for purposes of school identification or insurance reimbursement). However, now I worry there will no longer be a hole into which to do any squeezing. I can think of 20 kids I've seen in the last month that have a genuine writing disorder. What do they have now? DSM proposes the broad category "Learning Disability" for the first time.

A Reading Disorder can no longer include difficulty in reading comprehension. Arg, we lose focus on the fact that the process of reading is making sense of text (not just pairing sounds and symbols rapidly). I love the irony of a spelling mistake in APA making the case that reading is only decoding:

The new name for a reading disorder is "dyslexia;" a disorder of mathematics is "dyscalculia." Turning back the clock? The stated intention is to be more consistent with international use. Then, one line later, the APA cites US legislation (reauthorization of IDEA) to de-emphasize the use of discrepancy in identifying a learning disability. US legislation determines whether someone has a mental disorder? That bill was passed so that congresspeople could get re-elected or pass their pork-barrel projects, and the DSM cites this alongside peer-reviewed academic research to justify their clinical category?

I'll blog at some other time about the various proposals to make sense of AD/HD. That will end up being the biggest change for children in the DSM-V.

DSM-V goes into effect 2013. They are accepting comments beginning in April. I'll put in my two cents.

At this point, I'm reeling from the shock. After IDEA was reauthorized, I could at least hang my hat and thinking in the DSM world. Now these changes worry me even more. Before I rant too much more, I should probably make sure I'm sure I'm not just over-reacting to change. Oh look! No Worries! The new DSM has a new category for me and all those who share my concerns: Adjustment Disorder With Mixed Anxiety and Depressed Mood

Thursday, February 4, 2010

To build on the post by Anonymous:One of the things we struggle with in our field is terminology. Learning Disabilities? Learning Differences? Dyslexia? Specific Learning Disorders? How can we purport to know anything about learning and it's individual variations if we don't even know what to call it?For one, we can rest assured that the choices are better today than they were more than 40 years ago. I would hate to tell a kid to their face that they had "minimal brain damage" or to explain that they were "educably handicapped" (or as my 17yr old used to say, "candilapped"). Reading disorders used to be named according to what they looked like, such as "word blindness" or to make it really fancy, put it in Latin: "Strephosymbolia" (twisted symbols).

Ever since the early coinage of the term LD in the late 1960's, the field has struggled to separate itself on one hand from more general mental delays (hence, the addition of "specific") and also differentiate itself from "normal" developmental variation (hence the prefixes DISability or DYSlexia).

I do find "disability" to be a misnomer, because I spend much of my treatment hours persuading children that they ARE able, given the right strategies, practice, etc.

In my own mind, the lack of agreed upon terminology reminds me to be humble. What medical field would still not have a name for the disease they are curing? "Hmm, should we call it Cancer, or..." The fact that we don't even have our terms straight yet tells me how early we are in our thinking. No blood tests yet, no diagnostic fMRIs, no Hippocrates to lay down the tenets of ethical treatment ("First, do no test bias"). I guess it could be encouraging that the field of Physics still hasn't quite settled on whether LIGHT (the most trusted way we could be said to know something directly) is a particle or a wave. Sounds a little bit like our field of LD calling it one thing to a kids face and another thing to a suit-sporting table of professionals at an IEP. In the mean time, while we muddle through our terminology differences and DSM revisions, I tap back into that humility notion and listen to the way that kids talk about their own struggles. That's probably the best way to find out what it feels like from the inside out, and it's the best way to know whether they have recovered, or compensated, or overcome their, um, their...oh, whatever you want to call it.

Wednesday, February 3, 2010

I have to fess up to one of my educational fantasies. Often, I’ll be working with a kid, and I imagine what learning would be like without cognitive roadblocks. What we ALL would be like without these roadblocks, but especially them, right here and now.

I see the seeds of some good idea that the world needs to know about, and it isn’t coming out. The darn handwriting just doesn’t get it out fast enough before the darn monkeymind jumps on to some new thought. Or the words weren’t accessible - just stuck right there on the tip-of-her tongue - so why try to explain it anyhow.

I feel similar frustration trying to get needed ideas in. A 9-year-old can give me a phenotypical run-down on the difference between Indian and African elephants, but her brain never downloaded the sound-symbol codebook to be able to read a first-grade book about them (“Huh? A Frickin’ Elephant?!”).

What would life be like without these roadblocks, these input-output issues, these cognitive bottlenecks? Imagine the DaVinci Flying Machine that was never made because of poor visual-spatial skills. Or The Great American Novel never written due to waning attentional skills. Arg.

Often my fantasy of untapping potential drives my remediation sessions with a kid; I’m madly running through my ever-increasing key ring, fervently jamming well-used (or newly constructed) keys into quickly rusting locks. Then quickly trying to duplicate the keys and hand them over before a session ends, or a kid wants to just do homework, or some new profound tangent pulls us away.

But sometimes I am of the mind that these cognitive bottlenecks are a GOOD thing. Perhaps they hold gifts wrapped in frustration.

For one, the process of figuring out ones’ learning is a more powerful tool than effortlessly gliding through school and then hitting a brick wall and having no way to recover. I worry about this when I see an 11-year-old with working memory skills in the very superior range (stronger than 98% of their same-age peers) and executive functioning/organizational skills within the borderline range (below the 9th %ile), who rightly claims “Nah, I don’t need an assignment notebook because I remember my assignments.” [No doubt he does, but there’s no way to undo those compensatory mechanisms and learn how to use an assignment notebook in Junior Year of High School in AP Class content.]

And does my image of unfettered potential even exist? A disembodied black box mind that effortlessly inputs information and exudes brilliance with no friction or resistance? I am too much a believer in Whorfian thinking and know that language and culture must change our thoughts. So a kid with an auditory processing or language disorder would be a different thinker without the bottlenecks. And I like this kid’s mind too much to be trying to change it!

A final reason cognitive bottlenecks may ultimately serve us is that they lead us toward our proclivities. Although extreme, consider the likes of Stephen Hawking, of Temple Grandin, of the Jill Bolte Taylors of the world. Annie Sullivan had almost completely lost her own eyesight before learning sign language and meeting Helen. Although clearly nowhere on the same scale of genius, personally, I have no doubt that my own frustrations coming up with that right word on the spot have led me toward expressing my truest thoughts and feelings non-linguistically through music. I don’t know where I would be without busking, writing songs, and gigging regularly.

Ultimately, these days I find myself reconciling my fantasies for unfettered potential (more Darwin flying machines!) and my respect for our existing neurocognitive architecture with an ever deepening faith in process over product.

I’m learning that the keys we uncover in our resilience serve us well beyond the immediate ease of showing our smarts.

About Me

Jordi somehow can't get his mind to stop thinking about learning and teaching. He is currently in private practice conducting psychoeducational evaluations and directing a learning clinic.
http://learning-clinic.com